Here is something that I sometimes struggle with and would like any advice...

In my work with People who suffer from Alzheimer's Disease and other types of Dementia Disorders I often find myself in situations where the most compassionate response is a lie, or at the very least a half truth.

A good example is that of this a woman that is asking where her husband is. I reasure her that her husband will meet her at home although he died several years ago. Due to her memory loss she accepts this and has a good day. To tell her the truth at this point would be cruel and of no use from a professional standpoint but does it violate the Precept of Honestly or is it simply a Skillful Means to releive suffering?

Or, perhaps a bit more sticky...

Very sadly, there has been very little progress on a cure for Alzheimer's Disease. However, at times I find myself useing that catch phrase "there is always hope" with a family or deflecting a question of if someone could regain lost memories. (something that is very problematic at best as the Electro chemical foundation for these memories has been disrupted and can't be retreved even if a cure were to be avalible.)

I just don't have the heart to just be honest in these cases, and tend to even be a bit positive.

Do these actions truly violate any of the Precepts or does compassion and the wish to help those who are suffereing override any negitive aspect?

Regarding "therapeutic lying," it may be helpful to address the question of "who's needs are we trying to meet?" Our need may be for the person to be alert and oriented to person, place and time as much as possible. However, the person may, as you mentioned, need comfort and perceived safety. In that case, offering comfort is the higher priority, as your intention is to meet the person's need.

Regarding "hope:" In hospice, families would often ask the staff, "Is there any hope?" What we offered was that, yes, there is hope. Not hope for a cure, as there may not be a medical cure, but hope that the person will have good days, have loving family present, be pain free and as comfortable as possible. The focus of hope shifts from cure to comfort. Many families found this helpful. Perhaps your Alzheimer's families would, too.

Thank you for your kindness and concern in such a difficult situation. May you receive much merit!

Often, when self-doubt strikes, it is helpful to reflect on intentions. What was your intention in lying to the Alzheimer's patient about her husband? Was the intent to deceive or to comfort? In such situation where there is a conflict between precepts, compassion can be used as a guideline for right action.

I don't know if it's the same for Alzheimer's, but when we were trained for psychiatric wards in nursing school (I never worked at an actual ward though) we were specifically instructed never to indulge or play along with the psychoses or hallucinations of the patients. it's just not helpful and induces further belief in their delusions, even if it may seem like it might be easier in the short term to play along to calm them down, tend to them or whatnot.

In regards to relatives and hope, I don't think there is necessarily anything wrong in putting an optimistic spin on things, but it has to be in keeping with reality. If the actual chances of any recovery are minuscule, then you need to impart this to them in a proper and truthful fashion without distortion. I think even in the worst of cases, this still does present plenty of leeway for different perspectives along the spectrum of despair/acceptance/hope and you'd want to mediate away from despairing perspectives. I think it is doing them a disservice to distort fact or rational probability in the service of hope though.

"Even if my body should be burnt to death in the fires of hellI would endure it for myriad lifetimes As your companion in practice" --- Gandavyuha Sutra

Just my personal opinion, but one drawn from a significant amount of antedotal experience with these things..

for a person with a psychosis or some such that is producing hallucinations and such the proper thing is to bring them to the real as much as possible.

Alzheimers is in fact not similiar to that state and is always gradually progressing. Though it may present similiarly. That one remembers she has a husband may soon become a good thing or day. So inciting the memory itself may act as a mental stimulant of some sort and part of this things progression is slowed with such stimulations. So it matters not so much what they are told the thinking itself in response to a question answered is productive.Told your husband will be home tonight and remembered for a entire day would be actually a very early stage of this thing. Remembering not asking you the question a minute before asking it again that is more typical to my experience. Saying hello to you as if you had just walked into the room when you had been in the room all day....that is also typical.

How the mind responds to the deficiency is I'd guess critical to the progression. This seems like a nice person. Some unfortunately take their loss in a paranoid or violent way and act it out. ONe acquaintance of mine was caring for his mother and awoken one night to find her trying to smother him with a pillow....most disconsorting.

I'd personally try to make each as happy as possible if anything one could say would.That's what I would and have done. To point out their inadequacy even if in the desire to tell the truth.....most get upset and some quite sad. Would I tell a patient saying hello 20 times in one hour....I just said hello to you....never.They would not know what to make of it.Occasionally other dementia or even undiagnosed mental illness is quite unfortunately lumped in with alzheimers.Some people have always had mental illness but due to family and such isolation have never had it diagnosed. In a group setting, it becomes apparent they are not quite right but elderly it is assumed it is alzheimers. So not always is the progresssion the same. But that is rare.

To add finally...I would never think for a minute effectively lying to such people violates any precept of Buddhism.

"This order considers that progress can be achieved more rapidly during a single month of self-transformation through terrifying conditions in rough terrain and in "the abode of harmful forces" than through meditating for a period of three years in towns and monasteries"....Takpo Tashi Namgyal.

i understand that Cholesterol ( the good one ) is required for good membrane health and since the brain is a major organ, that the anti Cholesterol drugs ( for the bad one ) that prevent artery clogging, perhaps has an affect on the brains health and maybe linked to the increase in alzheimers.

"If you deprive cholesterol from the brain, then you directly affect the machinery that triggers the release of neurotransmitters," said Shin. "Neurotransmitters affect the data-processing and memory functions. In other words -- how smart you are and how well you remember things."

I personally expect a pandemic of alzheimers shortly. Something, whatever it is seems to be affecting the cognitive abilities of people in the US. There are many theories as to cause that it is happening seems indisputable. As we naturally decline in mental capacity with age some people seemingly have not so far to fall. It is progressive and many years of productive happy living can be attained before its onset becomes terminal.How soon it becomes terminal by my guess has to do a lot with intellectual capacity and response to the disorder.

Not wanting to take cholestorol lowering drugs as it increase the risk of alzheimers...one more reason to be vegan.

One conclusively proven cause is welding without a respirator. There is absolute proof of the connection.Why this is not readily known and available has everything to do with litigation and corporate interest and influence. Now such is mandated, by OSHA, but in the day welding was always sans respirator. However I still see welding done quite commonly without protection.

Albolutely conclusively if you weld for a large amount of time years without respiratory protection...you will get alzheimers.It's been years since I looked into the exact cause but my guess is wikipedia probably has something about it. manganese perhaps, the welding rods I think.Technically it may be considered a form of heavy or other metal poisioning. But functionally it is exactly alzheimers.

When introduced to a elderly male with alzheimers I always start with...well then were you a welder? At least 25% of the time the response is affirmative, if they are able to be quaried of course.Makes you wonder about modern medicine why a known cause of a growing health cirisis is really not talked about...seems it would connect perhaps to other forms. People were half right at least when they used to say it was aluminum in the brain and thusly not to eat on aluminum pots.

"This order considers that progress can be achieved more rapidly during a single month of self-transformation through terrifying conditions in rough terrain and in "the abode of harmful forces" than through meditating for a period of three years in towns and monasteries"....Takpo Tashi Namgyal.

Technically it may be considered a form of heavy or other metal poisioning.

&

People were half right at least when they used to say it was aluminum in the brain and thusly not to eat on aluminum pots

This is very interesting - I remember about 20 years ago I was in a health shop and chatting to the staff and they suggested a non-aluminum deodorant for the reason of possibly being linked to alzheimers. Ever since, I have been somewhat wary of aluminum, as I trusted their advice. With the excess levels of many metals present in quite a few tap waters in the Western world today, I wonder if drinking water would be another possible cause to consider? (I am interested in such matters, but have not done much research as yet.)

I think the original aluminum supposition was based on increased levels of alum in the brain cells. But as to how that got there, is questionable. Cooking could I guess possibly but normally aluminum is pretty inert. Even if you ground it up and consumed the filings it would just pass through.

With the welding a disease presents called mangniasumitus(or something like that). Parkinsins presents principally as a walking talking inability to do things thing, except perhaps a very advanced state. Normally the victim will present with a normal cognitive state excepting perhaps in very very progressed disease. Some loss of cognition is present in some peoples early on but I would more equate it with that which presents with a person being under the condition of depression...or not that bad. That magnagisumitus disease, which is produced from breathing the welding rods smoke, is very similiar to Parkinsins in many cases, however it does present sometimes with loss of memory, loss of ability to do cognitive tasks, agressive behaviors....which are more similiar to classic alzheimers.

So it appears to me at least the maganisum precipitating disease, does produce classical alzheimers symptoms in some of those so exposed.And as stated to my antedotal experience at least 25% of those elderly males with alzheimers does have some welding work history.Of course with the now present OSHA requirements for respiritory protection less will present over time.

With magnesium it is the smoke that enables it to attach to brain cells,destroying ability to process certain nerve impulses.So I'd guess a metal exposure of some kind may be indicated the question becomes how does it become ingested to produce harm.Normally as with cooking you would not expect aluminum to be in a form which attaches to the body.

Of course with alzheimers there is so much called alzheimers which could be hypoxic effect causeing death or damage upon brain cells due to stroke ischemic attack or other vehicle. What apppears as alzheimers..... may in fact be something entirely different.A person with a blood clot which affects a certain part of the brain, for instance, may produce exactly, alzheimers symptoms, abeit without the progression normally identified.

Alzheimers is normally a progressive disease which presents usually with no specific causitive factor such as cerebral embolism.

Of course I wouldn't exclude other factors as Heruka mentioned. Alzheimers as with cancer may be found to be a very broad catagorization with many multiple subsets of causitive and symptomatic evidence is my guess. So some may be caused by a cholesterol lowering drug and some may be caused by welding smoke.

Protection from litigative result to my opinion does help to cloud whatever research is out there with interest by industry or corporation to protect.

Tap waters are also a bugaboo of sorts. Municipalities are inclined to work against safe standard work and imposition of such through legislative actions. For instance arsnic(found in waters that pass through rocks or soils with significant volcanic matter) has been found to produce many deletrious effects in low doseages. Skin cancer, cognitive negative effect, perhaps even heart disease, amongst others. Yet though knowing of the danger and despite it being present in many tapwaters,(such as from certain wells in Albuquerque New Nexico) little has been done to stop or filter for this material. It is just way to expensive for many municipalities...So they drink water that is poisioned because they can't afford to clean it basically.

So yes I would be careful of what one finds in tap water. Bottled water or some home filters perhaps provide a additional level of filtration that municipalities do not do, reverse osmosis or carbon filtration.So it is perhaps safer. However spring water bottled has no such filtration on occasion.Perhaps thinking.... oh how nice water from a hot spring millions of years old....well hot spring perhaps meaning derived from water that passes through volconic materials. So everything has to be qualified.Arsnic is particularly insideous in its presentation to my dim recollection. Cognitive effect and neurological deficit present in overt cases of poisioning. Skin cancers and others in lower levels.

"This order considers that progress can be achieved more rapidly during a single month of self-transformation through terrifying conditions in rough terrain and in "the abode of harmful forces" than through meditating for a period of three years in towns and monasteries"....Takpo Tashi Namgyal.